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Outcomes in severe sepsis and patients with septic shock: pathogen species and infection sites are not associated with mortality.
Crit Care Med. 2011 Aug; 39(8):1886-95.CC

Abstract

OBJECTIVES

We evaluated the respective influence of the causative pathogen and infection site on hospital mortality from severe sepsis related to community-, hospital-, and intensive care unit-acquired infections.

DESIGN

We used a prospective observational cohort 10-yr database. We built a subdistribution hazards model with corrections for competing risks and adjustment for potential confounders including early appropriate antimicrobial therapy.

SETTING

Twelve intensive care units.

PATIENTS

We included 4,006 first episodes of acquisition-site-specific severe sepsis in 3,588 patients. INTEVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS

We included 1562 community-acquired, 1432 hospital-acquired, and 1012 intensive care unit-acquired episodes of severe sepsis. After adjustment, we found no independent associations of the causative organism, multidrug resistance of the causative organism, infection site, or presence of bacteremia with mortality. Early appropriate antimicrobial therapy was consistently associated with better survival in the community-acquired (0.64 [0.51-0.8], p = .0001), hospital-acquired (0.72 [0.58-0.88], p = .0011), and intensive care unit-acquired (0.79 [0.64-0.97], p = .0272) groups.

CONCLUSION

The infectious process may not exert as strong a prognostic effect when severity, organ dysfunction and, above all, appropriateness of early antimicrobials are taken into account. Our findings emphasize the importance of developing valid recommendations for early antimicrobial therapy.

Authors+Show Affiliations

Infection Control Unit, Necker University Hospital Paris, Assistance Publique-Hôpitaux de Paris, Paris, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

21516036

Citation

Zahar, Jean-Ralph, et al. "Outcomes in Severe Sepsis and Patients With Septic Shock: Pathogen Species and Infection Sites Are Not Associated With Mortality." Critical Care Medicine, vol. 39, no. 8, 2011, pp. 1886-95.
Zahar JR, Timsit JF, Garrouste-Orgeas M, et al. Outcomes in severe sepsis and patients with septic shock: pathogen species and infection sites are not associated with mortality. Crit Care Med. 2011;39(8):1886-95.
Zahar, J. R., Timsit, J. F., Garrouste-Orgeas, M., Français, A., Vesin, A., Vesim, A., Descorps-Declere, A., Dubois, Y., Souweine, B., Haouache, H., Goldgran-Toledano, D., Allaouchiche, B., Azoulay, E., & Adrie, C. (2011). Outcomes in severe sepsis and patients with septic shock: pathogen species and infection sites are not associated with mortality. Critical Care Medicine, 39(8), 1886-95. https://doi.org/10.1097/CCM.0b013e31821b827c
Zahar JR, et al. Outcomes in Severe Sepsis and Patients With Septic Shock: Pathogen Species and Infection Sites Are Not Associated With Mortality. Crit Care Med. 2011;39(8):1886-95. PubMed PMID: 21516036.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes in severe sepsis and patients with septic shock: pathogen species and infection sites are not associated with mortality. AU - Zahar,Jean-Ralph, AU - Timsit,Jean-Francois, AU - Garrouste-Orgeas,Maïté, AU - Français,Adrien, AU - Vesin,Aurélien, AU - Vesim,Aurélien, AU - Descorps-Declere,Adrien, AU - Dubois,Yohann, AU - Souweine,Bertrand, AU - Haouache,Hakim, AU - Goldgran-Toledano,Dany, AU - Allaouchiche,Bernard, AU - Azoulay,Elie, AU - Adrie,Christophe, PY - 2011/4/26/entrez PY - 2011/4/26/pubmed PY - 2011/9/22/medline SP - 1886 EP - 95 JF - Critical care medicine JO - Crit Care Med VL - 39 IS - 8 N2 - OBJECTIVES: We evaluated the respective influence of the causative pathogen and infection site on hospital mortality from severe sepsis related to community-, hospital-, and intensive care unit-acquired infections. DESIGN: We used a prospective observational cohort 10-yr database. We built a subdistribution hazards model with corrections for competing risks and adjustment for potential confounders including early appropriate antimicrobial therapy. SETTING: Twelve intensive care units. PATIENTS: We included 4,006 first episodes of acquisition-site-specific severe sepsis in 3,588 patients. INTEVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 1562 community-acquired, 1432 hospital-acquired, and 1012 intensive care unit-acquired episodes of severe sepsis. After adjustment, we found no independent associations of the causative organism, multidrug resistance of the causative organism, infection site, or presence of bacteremia with mortality. Early appropriate antimicrobial therapy was consistently associated with better survival in the community-acquired (0.64 [0.51-0.8], p = .0001), hospital-acquired (0.72 [0.58-0.88], p = .0011), and intensive care unit-acquired (0.79 [0.64-0.97], p = .0272) groups. CONCLUSION: The infectious process may not exert as strong a prognostic effect when severity, organ dysfunction and, above all, appropriateness of early antimicrobials are taken into account. Our findings emphasize the importance of developing valid recommendations for early antimicrobial therapy. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/21516036/Outcomes_in_severe_sepsis_and_patients_with_septic_shock:_pathogen_species_and_infection_sites_are_not_associated_with_mortality_ L2 - https://dx.doi.org/10.1097/CCM.0b013e31821b827c DB - PRIME DP - Unbound Medicine ER -